Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

TREATMENTS: ANTIBIOTICS AND PAINKILLERS

 

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Antibiotics


Painkillers


 

 

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Home > Treatments > Antibiotics and Painkillers

 


Overview


  • Neither antibiotics nor painkillers are a routine treatment for CKD cats.

  • However, sometimes a cat will need antibiotics to treat a bacterial infection such as a urinary tract infection or a dental infection.

  • Similarly, painkillers and/or anti-inflammatories may sometimes be required, perhaps following surgery or to help with arthritis.


Antibiotics


When to Use Antibiotics


Antibiotics are not an integral part of treating CKD, but their use is essential if your cat has a bacterial infection. In CKD cats, these are most commonly:

The good news is that although infections may make your cat sicker, and in the worst case may cause your cat to crash, getting the infection under control can make your cat feel much better and may even lead to an improvement in blood test results.

 

Length of Treatment


Most courses of antibiotics last for 5-14 days.

 

However, if your cat has a kidney infection (pyelonephritis), a longer course is necessary, for 4-8 weeks. Some UTIs also need a longer course of around four weeks.

 

Although most antibiotics start to show an effect within 48 hours, once you begin a course of antibiotics, it is very important that you complete the course, otherwise antibiotic resistance may occur (see immediately below).

 

If your cat reacts badly to an antibiotic, contact your vet and discuss changing to another type.

 

Antibiotic Resistance


Antibiotic resistance does not mean the cat is resistant to the antibiotic, or showing a bad reaction to it. Antibiotic resistance means the bacteria which are causing the infection have developed an immunity to the antibiotic, so will not be killed by it. US Centers for Disease Control and Prevention explain more about antibiotic resistance.

 

One reason antibiotic resistance occurs is if too short a course of antibiotics is given. This can mean the bacteria are weakened, but not all of them are killed, and the stronger bacteria which were not killed will regroup and develop resistance to the antibiotic. The next time these bacteria are exposed to that antibiotic, it will not kill them.

 

Ideally you want to give an antibiotic to which you know the bacteria will respond. The best way to do this is through a culture and sensitivity test, which identifies to which antibiotics the bacteria are susceptible. This enables you to only give an antibiotic which is known to be effective for your cat's infection.

 

Using Probiotics in Addition to Antibiotics


Antibiotics aim to eradicate the bacteria causing the infection. However, they will also eradicate "good" bacteria which normally protect the body from infection. Therefore, when giving antibiotics, you may need to re-balance the bacteria in the gut with probiotics ("good" bacteria).

 

This can be particularly important if your cat develops diarrhoea while on antibiotics. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis (2012) Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B & Shekelle PG Journal of the American Medical Association 307(8) pp1959-69 found that giving probiotics may help with this type of diarrhoea, though further studies are needed to determine which probiotics work best for which antibiotic.

 

Please see Treatments for more information.

 


Antibiotic Choices


 

The following antibiotics may be used in cats. Amoxicillin, enrofloxacin and clindamycin are those most commonly used in CKD cats:

Antimicrobial therapy in veterinary medicine (2013) 5th Ed. Gigučre S, Prescott JF & Dowling PM (Eds) Wiley Blackwell has extremely detailed information about antibiotics.

 


Amoxicillin and Clavulanate (Clavamox or Augmentin, Synulox or Noroclav)


 

Amoxicillin is an antibiotic in the penicillin family. It may be used alone, but for cats it is often combined with clavulanate, an inhibitor of an enzyme produced by bacteria (this enzyme could render the amoxicillin inactive if the clavulanate were not present). Combining the two means more bacteria should be killed than amoxicillin alone could achieve.

 

Trade names include Clavamox (veterinary formulation) or Augmentin (human formulation) in the USA and Synulox or Noroclav in Europe.

 

Mar Vista Vet discusses amoxicillin.

 

Mar Vista Vet also discusses amoxicillin with clavulanate acid.

Amoxicillin and Clavulanate Usage


This antibiotic is used for upper respiratory infections, urinary tract infections and dental infections. In the UK it tends to be the antibiotic which most vets prescribe routinely for many infections.

 

In CKD cats it is often prescribed for urinary tract infections.

 

Amoxicillin and Clavulanate Formulations


There are a number of different formulations available, including tablets, flavoured chews, injectable and an oral suspension. Synulox in the UK comes in flavoured pills (known as "pink sweeties" in our house) which Harpsie would happily eat out of my hand.

 

Other formulations include Clavamox, which comes as a 62.5mg tablet, a 62.5mg chewable flavoured tablet and an oral suspension with 62.5mg per ml; and Noroclav chewable tablets, which are available in the UK in 50mg and 75mg size.

 

Amoxicillin and Clavulanate Dosage


For amoxicillin alone (i.e. without clavulanate), Pet Place states "The dose of amoxicillin ranges from 5 to 12 mg per pound (10 to 25 mg/kg) two or three times a day orally. This would mean that a 10lb (4.5kg) cat would receive 50 to 120 mg two or three times a day of amoxicillin.

 

Referring to the Canadian amoxicillin 100mg tablets Drugs talks about "a dosage rate of 11-22 mg/kg once daily" for cats, which is broadly similar to the Pet Place recommendation. However, it also says "In severe urinary tract and gastrointestinal tract infections requiring high concentration, the above dosages should be doubled."

 

This may not be appropriate for CKD cats. Drugs says of the Canadian 100mg tablets "Since Amoxicillin 100 is excreted mostly by the kidneys, reduce the dosage for patients with renal impairment in proportion to the degree of loss of renal function." Urinary tract infection: how to diagnose and treat correctly (2003) Brovida C Presentation to the World Small Animal Veterinary Association World Congress outlines how to modify the dosage for cats with kidney disease.

 

For Clavamox (which contains both amoxicillin and clavulanate), Pet Place states "the most common dose of clavamox used in dogs and cats is 6.875 mg per pound (13.75 mg/kg) every 12 hours." This would mean that a 10lb cat would receive 68.75mg twice a day, slightly more than that recommended by Drugs, which says "The recommended dosage is 62.5 mg twice a day.

 

Be guided by your vet as to the most suitable dosage for your cat.

 

Pet MD says of amoxicillin "This drug should be given for at least 7-10 days to be effective."

 

Drugs says of Clavamox "The maximum duration of treatment should not exceed 30 days."

 

Amoxicillin and Clavulanate Side Effects


Unfortunately this medication can cause loss of appetite, lethargy, drooling, vomiting and diarrhoea in some cats. My Karma just could not tolerate it for more than a few days. Apparently it is not uncommon for cats to be fine for a few days on this antibiotic but then exhibit side effects towards the end of the course. 

 

Giving food before you give the antibiotic may help, as may probiotics (see above), but if not, contact your vet to see if you should switch to a different antibiotic. Your vet may wish to try amoxicillin without the clavulanate, or may wish to use a different type of antibiotic. Do not simply stop giving the medication because this may make the infection return (see above). 

 


Enrofloxacin (Baytril)


 

Enrofloxacin belongs to the fluoroquinolone family of antibiotics. Trade names include Baytril and Zeden. Like amoxicillin, it is a broad spectrum antibiotic (i.e. it works on a wide range of bacteria). In high doses, it may in rare cases cause blindness.

 

Mar Vista Vet has a good overview of enrofloxacin.

 

Pet Place has some information about enrofloxacin

 

Enrofloxacin Usage


Enrofloxacin is a powerful antibiotic and is not normally used for minor infections. Summary of product characteristics says "Fluoroquinolones should be reserved for the treatment of clinical conditions which have responded poorly, or are expected to respond poorly, to other classes of  antimicrobials. Wherever possible, fluoroquinolones should be used based on susceptibility testing."

 

Enrofloxacin is a popular choice for kidney infections (which can be difficult to treat), where it appears able to reach bacteria deep in the kidneys which less powerful antibiotics cannot touch. One of my cats was prone to kidney infections and enrofloxacin saved his life on several occasions.

 

The manufacturer states that this class of antibiotics is not considered to be harmful to the kidneys, and that tests on dogs indicated no evidence of kidney damage even at high dosing levels. However, ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease (2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "Avoid enrofloxacin in cats with CKD due to increased risk of retinopathy at standard therapeutic doses.” See below for more on this.

 

Enrofloxacin Formulations


Enrofloxacin in widely available in 15mg tablet form. It doesn't taste very nice, so it is also available as a chewable tablet called Taste Tabs.

 

There is an injectable form of enrofloxacin but it is only approved for dogs. Some people have used it for cats, but this is not recommended because there is a small risk of an abscess at the injection site. Occasionally, however, a vet will start the treatment plan with an injection and then the course of treatment will continue at home with tablets. Plumb's Veterinary Drug Handbook (7th Ed.) says "Use of the canine or bovine injectable products in cats is controversial and may result in significant adverse effects. Parenteral administration in cats at doses less than 5 mg/kg have reportedly caused ophthalmic toxicity (blindness)."

 

Enrofloxacin Dosage


The official recommended tablet dose in most countries is 5 mg of enrofloxacin per kg of bodyweight per day. 

 

For the injectable version, the usually recommended dose is 1ml per 5 kg of cat, which is the equivalent of 5mg per kg of bodyweight.

 

This is the recommended total daily dose for cats of the following weights:

 

Cat Weight lb Cat weight kg Recommended dose mg
5 lb 2.27 11.25
8 lb 3.64 18.20
10 lb 4.50 22.5

 

The dosage of 5mg per kg of bodyweight was introduced because of the risk of higher doses causing blindness in cats. The issue did not arise until the recommended dosage limits were dramatically increased, and once the issue became known, the reduced dosage of 5mg per kg daily was introduced. See below for more on the blindness issue.

 

For the overwhelming majority of cats, this is a safe dosage, because, according to Baytril, 16 of the 17 cats who developed blindness were given doses six to ten times higher than the recommended dose. However, the other cat in the study who became blind had received a dose of only 4.6 mg/kg. This cat was fifteen years old.

 

Enrofloxacin-associated retinal degeneration in cats (2001) Gelatt KN, van der Woerdt A, Ketring KL, Andrew SE, Brooks DE, Biros DJ, Denis HM, Cutler TJ Veterinary Ophthalmology 4(2) pp99-106 reports on the risks of blindness and recommends adhering closely to the guidelines regarding the maximum recommended dose.

 

Plumb's Veterinary Drug Handbook (7th Ed.) states "Patients with severe renal or hepatic impairment may require dosage adjustments to prevent drug accumulation." Urinary tract infection: how to diagnose and treat correctly (2003) Brovida C Presentation to the World Small Animal Veterinary Association World Congress outlines how to modify the dosage of enrofloxacin for cats with kidney disease.

 

Enrofloxacin may be given once daily or twice daily according to Plumb's Veterinary Drug Handbook. However, the manufacturer states "once daily application of the total dose of fluoroquinolones will have greater therapeutic effect compared to treatment regimens where the dose is divided into two applications." Therefore I would opt to dose once daily.

 

The manufacturer also states that research in dogs indicates that enrofloxacin is most effective when given one hour before food, preferably wet food. Plumb's Veterinary Drug Handbook (7th Ed.) states "This drug is best given on an empty stomach without food, but if your animal vomits or acts sick after getting it, give with food or small treat (no dairy products, antacids or anything containing iron) to see if this helps."

 

The recommended maximum course of treatment is 30 days (although Harpsie was on a longer course a couple of times for his kidney infections with no problems).

 

Enrofloxacin Side Effects


Possible side effects include nausea, vomiting or diarrhoea, though from what I have seen over the years, these side effects seem to occur far less commonly than they do with amoxicillin. Plumb's Veterinary Drug Handbook (7th Ed.) says "enrofloxacin appears to carry a low risk of causing antibiotic-associated diarrhea."

 

The main concern with enrofloxacin is that in certain rare cases it has caused retinal problems, including blindness, when given to cats in high doses. Summary of product characteristics (2017) DEFRA (UK Department for Environment, Food and Rural Affairs) states "In target animal studies, cats have been shown to suffer ocular damage after receiving doses of more than 15 mg/kg once daily for 21 consecutive days. Doses of 30 mg/kg given once daily for 21 consecutive days have been shown to cause irreversible ocular damage. At 50 mg/kg given once daily for 21 consecutive days, blindness can occur."

 

The blindness has reversed in some cases once enrofloxacin is stopped, but not in all.

 

Plumb's Veterinary Drug Handbook (7th Ed.) says "Use of the canine or bovine injectable products in cats is controversial and may result in significant adverse effects. Parenteral administration in cats at doses less than 5 mg/kg have reportedly caused ophthalmic toxicity (blindness)."

 

The manufacturer states that this class of antibiotics is not considered to be harmful to the kidneys, and that tests on dogs indicated no evidence of kidney damage even at high dosing levels. However, ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease (2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "Avoid enrofloxacin in cats with CKD due to increased risk of retinopathy at standard therapeutic doses.”

 

Summary of product characteristics says "Use the product with caution in cats with severe renal or hepatic impairment."

 

Small Animal Clinical Pharmacology (2nd Ed.) (2008) Maddison JE, Page SW & Church DB Saunders Ltd says “It has been postulated that the relatively open blood-brain barrier of cats combined with the lipophilic properties of enrofloxacin predispose cats to accumulating high concentrations of the drug in the CNS. The risk may be higher in cats with urinary tract infections and concomitant renal failure and care should be taken with dosage in geriatric cats or those with liver or renal impairment.”

 

Enrofloxacin may lower the seizure threshold, so may not be the best choice in cats with a tendency to have seizures. Although Harpsie had epilepsy, fortunately for us he never had any problems with enrofloxacin.

 

Plumb's Veterinary Drug Handbook (7th Ed.) says "Injectable enrofloxacin must not be mixed with, or come into contact with any IV solution containing magnesium (e.g., Normosol-R, Plasmalyte-R, -A, or –56); morbidity and mortality secondary to micro-precipitants lodging in patients’ lungs have been reported."

 

Enrofloxacin Interactions


Enrofloxacin must not be given orally within two hours of products containing calcium, aluminium or lanthanum (such as phosphorus binders) or iron (such as Pet Tinic), because they may inhibit absorption of the enrofloxacin. 

 

Sucralfate must also be give separately from enrofloxacin for the same reason. Drugs has some information about this.

 


Marbofloxacin (Marbocyl or Zeniquin)


 

Marbofloxacin belongs to the fluoroquinolone family of antibiotics, the same family as enrofloxacin (Baytril) and pradofloxacin (Veraflox). Trade names include Zeniquin and Marbocyl.

 

Pet Place has some information about marbofloxacin.

 

Mar Vista Vet has an overview of marbofloxacin.

Marbofloxacin Usage


Marbofloxacin is used for skin, upper respiratory or urinary tract infections, especially those which are not responding to other antibiotics.

 

Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases (2011) Weese SJ, Blondeau JM, Boothe D, Breitschwerdt EB, Guardabassi L, Hillier A, Lloyd DH, Papich MG, Rankin SC, Turnidge JD & Sykes JE Veterinary Medicine International pp1-9 says "reserve for documented resistant UTIs but good first-line choice for pyelonephritis."

 

Marbofloxacin Formulations


Marbofloxacin is only available in tablet form in the USA, starting with a 25mg size.

 

In Europe, tablets start at 5mg size. Injectable marbofloxacin is also available in Europe.

 

Marbofloxacin Dosage


The usual dosage is 2.5mg per kg bodyweight (1.25mg per pound of body weight) once per day.

 

For urinary tract infections, it should be given for at least ten days. It can be given for up to thirty days if necessary.

 

ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease (2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "Consider dosage adjustment. Adjust dose in moderate or severe CKD (IRIS stages 3 and 4).”

 

Marbofloxacin Side Effects


Possible side effects include nausea, vomiting (less than 1% of cats), or diarrhoea (2.1%).

 

Summary of product characteristics (2016) DEFRA (UK Department for Environment, Food and Rural Affairs) states "At the therapeutic recommended dosage, no severe side-effects are to be expected in dogs and cats."

 

Marbofloxacin may lower the seizure threshold, so may not be the best choice in cats with a tendency to have seizures.

 

There is some debate as to whether marbofloxacin can also cause blindness, as occasionally has happened with enrofloxacin. Plumb's Veterinary Drug Handbook (7th Ed.) says that as at July 2007 the FDA Adverse Drug Reaction database had received 14 reports of blindness associated with marbofloxacin. Baytril says "Orbifloxacin and marbofloxacin, other fluoroquinolones approved for use in dogs and cats, have also been reported to cause retinal damage and/or blindness in cats. Results of these studies lead to the conclusion that most veterinary approved fluoroquinolones show variable affinity for retinal tissues in cats."

 

Marbofloxacin Interactions


Marbofloxacin must not be given orally within two hours of products containing calcium, aluminium or lanthanum (such as phosphorus binders) or iron (such as Pet Tinic), because they may inhibit absorption of the marbofloxacin. 

 

Sucralfate must also be give separately from marbofloxacin for the same reason.

 


Pradofloxacin (Veraflox)


 

Pradofloxacin, trade name Veraflox, is a third generation antibiotic in the fluoroquinolone family of antibiotics, the same family as enrofloxacin (Baytril) and marbofloxacin (Zeniquin).

 

Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats (2007) Litster A, Moss S, Honnery M, Rees B, Edingloh M &Trott D Journal of Veterinary Internal Medicine 21(5) pp990-5 says it is "designed to restrict the emergence of antimicrobial resistance during therapy."  The manufacturer explains more about how it does this.

 

Second International Veraflox Symposium Proceedings (2012) provide information on pradofloxacin.

Pradofloxacin Usage


Pradofloxacin is approved for the treatment of respiratory and skin infections in cats. It is not approved for the treatment of urinary tract infections in cats (it is in dogs), but Bacterial urinary tract infections (2016) Dowling PM Merck Veterinary Manual says "Pradofloxacin is only approved for skin infections in cats in North America, but it is approved for treatment of UTI in dogs in Europe and is used to treat feline UTI."

 

Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats (2007) Litster A, Moss S, Honnery M, Rees B, Edingloh M &Trott D Journal of Veterinary Internal Medicine 21(5) pp990-5 found it "is a highly effective and safe antimicrobial treatment for bacterial lower urinary tract infection in cats."

 

Bacterial urinary tract infections (2016) Dowling PM Merck Veterinary Manual does say, however, "fluoroquinolones should be reserved for UTIs that involve gram-negative bacteria, especially Pseudomonas, and for UTIs in intact male dogs and cats because of their excellent penetration into the prostate gland and activity in abscesses."

 

Pradofloxacin Formulations


Pradofloxacin is available in both tablet form and in a 2.5% (25mg/ml) liquid suspension that the manufacturer states is designed to be palatable to cats. Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats (2007) Litster A, Moss S, Honnery M, Rees B, Edingloh M & Trott D Journal of Veterinary Internal Medicine 21(5) pp990-5 found "the palatable formulation optimizes owner compliance."

 

Pradofloxacin Dosage


Pradofloxacin is usually given once a day. Bacterial urinary tract infections (2016) Dowling PM Merck Veterinary Manual says "They are concentration-dependent killers with a long postadministration effect, so once daily, high-dose therapy for a relatively short duration of treatment is effective."

 

The manufacturer recommends a course of 3-5 days treatment for an upper respiratory infection in cats. For urinary tract infections in dogs it recommends a 7-21 day course of treatment. Clinical efficacy and palatability of pradofloxacin 2.5% oral suspension for the treatment of bacterial lower urinary tract infections in cats (2007) Litster A, Moss S, Honnery M, Rees B, Edingloh M &Trott D Journal of Veterinary Internal Medicine 21(5) pp990-5 gave it for 11-30 days (median was 18 days) qand no adverse effects were reported.

 

Tablets


The usual dose is 3mg per kg of body weight. A 10lb (4.5kg) cat should therefore receive 13.5mg.

 

Since the tablets are only available in 15mg sizes, the manufacturer recommends the following (click on summary of product characteristics):

 

Cat Weight (kg) Number of 15mg Tablets Total Dose Given (mg per kg)
3.4 - 5.0 1 3.0 - 4.4
5.0 - 7.5 1.5 3.0 - 4.5

7.5 - 10.0

2

3.0 - 4.0

 

Oral Suspension


The usual dose is 5mg per kg of body weight.

 

The manufacturer has a table showing how much to give to cats of various weights.

 

Pradofloxacin Side Effects


One major advantage of pradofloxacin is that, unlike enrofloxacin and marbofloxacin, it does not appear to cause blindness. Baytril says "In the development phase of pradofloxacin (Veraflox), a specific study was designed to investigate the effects of this molecule on the feline retina. This study clearly demonstrated retinal and ocular safety of pradofloxacin in the cat at doses up to 50 mg/kg, i.e. an at least tenfold safety margin."

 

Pet Place mentions that "Administration can cause reversible drops in white blood cell counts. Drug should be discontinued if there is any unexplained drop in leukocyte, neutrophil and/or lymphocyte counts."

 

Pradofloxacin Interactions


Pradofloxacin must not be given orally within two hours of products containing calcium, aluminium or lanthanum (such as phosphorus binders) or iron (such as Pet Tinic), because they may inhibit absorption of the pradofloxacin. 

 

Sucralfate must also be give separately from pradofloxacin for the same reason.

 


Clindamycin (Antirobe)


 

Clindamycin belongs to the lincosamide family of antibiotics. One trade name is Antirobe.

 

Pet Place has an overview of clindamycin.

 

Mar Vista Vet has some information about clindamycin.

Clindamycin Usage


Clindamycin is approved for treating skin and dental infections in cats. It is often prescribed for dental problems because it is particularly good at killing anaerobic bacteria which are commonly found in the mouth. I have used it for this purpose in my own cats, and it is the antibiotic I would choose for this purpose.

 

Clindamycin should be used with caution in CKD cats - the normal dosage may need to be adjusted. Mar Vista Vet states "The manufacturer has recommended blood tests of liver and kidney function if use of clindamycin is to persist beyond 30 days."

 

Clindamycin Formulations


Clindamycin is available in 25mg and 75mg capsules. It is also available as a liquid medication in a 25mg/ml strength.

 

Clindamycin Dosage


The manufacturer recommends a dose for cats of 5-15 mg per pound (11-33mg per kg) once a day for a maximum of fourteen days.

 

Always give with food or follow with water to avoid damaging the oesophagus.

 

Clindamycin Side Effects


Clindamycin is notorious for tasting awful, so it may be better to give it in a gelcap.

 

Like most antibiotics, clindamycin may cause diarrhoea, vomiting and drooling.

 

Clindamycin (2015) Clarke M Plumb's Therapeutic Brief May 2015 says "Administer with caution in patients with very severe renal disease and/or hepatic disease accompanied by severe metabolic aberrations."

 


Cefpodoxime (Simplicef)


 

Cefpodoxime is an antibiotic in the cephalosporin class of antibiotics, the same family as cefovecin (Convenia).

 

Pet Place has some information about cefpodoxime.

 

Mar Vista Vet has an overview of cefpodoxime.

Cefpodoxime Usage


Cefpodoxime is commonly used to treat skin infections and urinary tract infections.

 

Cefpodoxime Formulations


Cefpodoxime is available in 100mg and 200mg capsules.

 

It is also available as a liquid medication in 50 mg/5ml and 100 mg/5ml strengths.

 

Cefpodoxime Dosage


A typical dose is 10 mg per kg (5mg per pound) of cat, given once a day, or 5 mg per kg (2.5 per pound) of cat, given twice a day. It can be given with or without food.

 

Drugs says "Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment as well as severity of infection in accordance with the individual product package labeling."

 

Cefpodoxime Side Effects


As with many antibiotics, loss of appetite, vomiting, lethargy and diarrhoea may be seen. Vomiting is the most common side effect with cefpodoxime.

 

Drugs says "Renal function tests should be performed periodically during prolonged and/or high-dose therapy, since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs."

 

Cefpodoxime Interactions


Mar Vista Vet says "Drugs that decrease stomach acidity (any antacids) may decrease absorption and thus efficacy of cefpodoxime." This would include medications such as famotidine (Pepcid), ranitidine (Zantac) and cimetidine (Tagamet).

 


Cefovecin (Convenia)


 

Cefovecin is a third generation antibiotic in the cephalosporin class of antibiotics, the same family as cefpodoxime (Simplicef). The brand name is Convenia.

Cefovecin Usage


Cefovecin under the brand name of Convenia was approved as follows:

  • in Europe in 2006 for the treatment of skin infections and urinary tract infections in cats and dogs.

  • in the USA in 2008 for the treatment of skin infections in dogs and cats, and urinary tract infections in dogs only.

The European Medicines Agency states "It is prudent to reserve third generation cephalosporins for the treatment of clinical conditions, which have responded poorly, or are expected to respond poorly, to other classes of antimicrobials or first generation cephalosporins."

 

The UK National Office of Animal Health states "The safety of Convenia has not been assessed in animals suffering from severe renal dysfunction."

 

Cefovecin Formulations


Cefovecin is only available as a subcutaneous injection. It lasts 14 days, so is very convenient, particularly for cats who hate to be pilled.

 

Efficacy and safety of cefovecin for the treatment of urinary tract infections in cats (2008) Passmore CA, Sherington J, Stegemann MR Journal of Small Animal Practice 49(6) pp295-301 found that an injection of cefovecin was as effective as a 14 day course of cephalexin.

 

Cefovecin Dosage


Pet Place mentions that "Maximum treatment should not exceed 2 injections." Other sources state that it may be used up to three times.

 

However, the manufacturer has stated (2013) that Convenia "should be administered as a single, one-time subcutaneous injection at a dose of 3.6 mg/lb (8 mg/kg) body weight."

 

If you do give it more than once, it should not be given more frequently than once every two weeks.

 

Cefovecin Side Effects


Possible side effects  include lethargy, vomiting and diarrhoea. There may also be skin irritation at the injection site.

 

Other more worrying possible side effects include haemolytic anaemia or pulmonary oedema, though fortunately these are rare. Drugs reports on possible side effects.

 

Cefovecin has not been tested in cats with severe kidney problems, but Drugs reports that some cats in a safety study had mild elevations in BUN and creatinine levels after they were given it.

 

There are a number of websites claiming that cefovecin is very dangerous for cats, and certainly some cats have had problems which might have been caused by the medication. Plumb's Veterinary Drug Handbook 7th Ed. states ""Hypersensitivity reactions, anaphylaxis and death associated with this drug are possible and have been reported." Center for Veterinary Medicine adverse drug events report listing (2013) reports (page 294) on the adverse effects reported to be associated with the use of cefovecin in cats up until 1 March 2013, including 166 deaths and 148 cases of anaemia. Whilst this is worrying, people never seem unduly concerned that 66 deaths were also reported as being associated with amoxicillin and clavulanate.

 

Cefovecin can remain in the body for up to 65 days. If your cat does have a bad reaction, the fact that it is so long lasting becomes a disadvantage, because your cat's body remains exposed to the drug.

 

Many people I have heard from who have used cefovecin were pleased with it. My Ollie was given this for a urinary tract infection and he did not show any adverse reactions, but his UTI symptoms began to return about 10 days after the shot, so we switched to amoxicillin and clavulanate, which seemed to work better for him.

 

Cefovecin Interactions


Famotidine (Pepcid AC) can interfere with antibiotics in the cephalosporin family such as cefovecin, so you should separate the two treatments by two hours. I am sometimes asked why I mention this when cefovecin is an injectable medication. H2-antagonist cephalosporin interactions (2003) Ali A Thesis states "These interaction studies with H2-receptor antagonists in gastric as well as blood pH revealed that simultaneous use of these drugs depressed the availability of the antibiotic as well as cimetidine, ranitidine and famotidine."

 

Plumb's Veterinary Drug Handbook does not mention cefovecin specifically, but does mention that taking other members of the cephalosporin family with food may offset the reduced absorption of the antibiotic.

 


Metronidazole (Flagyl)


 

Metronidazole is an anaerobic antibiotic which is not commonly used in CKD cats, but it is anti-inflammatory in the digest tract, so it can be very helpful for diarrhoea. Therefore it is often used in cats with colitis or IBD. It is occasionally used for dental problems, since oral bacteria are often anaerobic. Because of its anti-inflammatory effects, it is also sometimes used in cats with pancreatitis.

 

Metronidazole is known for its horrible taste.

 

Neurological problems can occasionally be seen, though these are rare and usually associated with either long term use (over a period of months) or high doses. The neurological problems usually resolve within a couple of weeks of stopping the medication. Pet Place discusses metronidazole toxicity but mentions it is uncommon and usually associated with long term use.

 

Mar Vista Vet has some information about metronidazole.

 


Painkillers and Anti-Inflammatories


 

CKD is not usually a painful disease, so painkillers are not normally part of a CKD treatment plan. However, CKD cats may sometimes require painkillers for other reasons, so here is some information about the various painkillers that may be used in cats.

Painkillers When to Use


The need for painkillers may be a short- or long-term requirement, depending upon whether the problem is acute or chronic.

 

Examples of acute need:

Examples of chronic need:

It is easier to stop pain developing rather than trying to control it once it has begun, so if for example your cat is about to have a dental, be sure to discuss pain control with your vet in advance.

 

If your cat is in pain, you must treat it.

 

Pain Assessment


Unfortunately it can be difficult to know when a cat is in pain. This is because firstly, cats instinctively try to hide the fact that they are in pain; and secondly, some of the signs of pain in cats are different to what you might expect, e.g. purring, restlessness. Other possible signs include growling, avoiding interactions, sleeping a lot or sitting in a hunched position.

 

Please see the Symptoms chapter for more information on the signs of pain in cats.

 

WSAVA guidelines for recognition, assessment and treatment of pain (2014) Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PVM, Wright B & Yamashita K Journal of Small Animal Practice 55(6) ppE10–E68 state "We cannot always know that our patient does hurt, but we can do our best to ensure that it does not hurt."

 


Painkillers Choices


 

Many painkillers which work well for dogs and humans are not tested on cats and therefore not approved for use in cats. Therefore most of the products discussed below are used off-label in cats.

 

It is wise to consider the use of additional treatments, such as nutraceuticals and/or acupuncture for arthritic cats and anti-nausea medications for cats with pancreatitis. This may enable you to lower the dose of the painkillers you are using. WSAVA guidelines for recognition, assessment and treatment of pain (2014) Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PVM, Wright B & Yamashita K Journal of Small Animal Practice 55(6) ppE10–E68 say "The authors recommend that particularly in all chronic pain patients, non-drug treatment modalities should be used alongside pharmaceutical treatments."

 

2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 has a helpful overview of the various painkillers available.

 

Newer options for chronic pain management (2011) Stein B Veterinary Anesthesia and Analgesia Support Group also discussed the various painkillers available.

 

This section covers a number of painkillers which tend to be used in cats, as follows:


Opiates


 

Opiates are narcotics, which means they belong to the same drug family as morphine. These drugs are  derived from the poppy and are the most powerful painkillers. 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "opioids are the most effective drug class for managing acute pain and can play a role in managing chronic pain."

Opioid therapy (2011) Thompson D Veterinary Anesthesia and Analgesia Support Group has an overview of opiates.

 


Buprenorphine (Buprenex, Vetergesic, Temgesic)


 

Buprenorphine, sometimes colloquially referred to as bupe, is a narcotic which is thirty times more potent than morphine. Trade names include Buprenex (USA), Vetergesic (UK) and Temgesic (UK and Australasia). Because it is such a powerful opioid, buprenorphine is a controlled substance in most countries.

 

Buprenorphine is a popular choice for cats because it works promptly and effectively, lasts for 6-8 hours (longer in some formulations), and has relatively few side effects.

 

Mar Vista Vet has an overview of buprenorphine.

 

Pet Place also has some information about buprenorphine.

 

Buprenorphine (2015) Claude A Clinician's Brief Jun 2015 pp31-32 explains more about buprenorphine.

Buprenorphine Formulations and Administration


Buprenorphine is available in an injectable form which  may be administered intravenously, intramuscularly, subcutaneously or transmucosally.

 

The intravenous and intramuscular methods of administration are normally only used in a clinic setting.

 

For home use, your options are therefore transmucosal application (oral) or subcutaneous injection.

 

Buprenorphine: Transmucosal (OTM or Intrabuccal)


Buprenorphine should not be given orally (as in, swallowed) because it is ineffective when given in such a way.

 

However, it is often given in transmucosal (intrabuccal) form, i.e. it is placed in the mouth (usually by being squirted from a syringe) between the cheek and the gum. When applied to the mucus membranes in this way, it can be easily and quickly absorbed by the body, within around 30 minutes, with its effects lasting for around eight hours.

 

Systemic update of buprenorphine by cats after oral mucosal administration (2003) Robertson SA, Taylor PM & Sear JW Veterinary Record 152(22) pp675-8 found that administering buprenorphine via the oral mucosal route was as effective as injecting it, and the majority of owners preferred this method of administration.

 

A review of the studies using buprenorphine in cats (2014) Steagall PVM, Monteiro-Steagall BP & Taylor PM Journal of Veterinary Internal Medicine 28 pp762-70 says "At clinical dosages... the buccal route has produced inconsistent results." However, WSAVA guidelines for recognition, assessment and treatment of pain (2014) Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PVM, Wright B & Yamashita K Journal of Small Animal Practice 55(6) ppE10–E68 say "buprenorphine given by the oral transmucosal route has been demonstrated to produce effective antinociception [pain blocking] in cats", and 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "The oral transmucosal or buccal route of administration for buprenorphine may have clinical efficacy as well." Certainly many members of Tanya's CKD Support Group find it seems to work well for their cats.

 

The buprenorphine used for this purpose is the standard (not the extended release versions) injectable form of buprenorphine.

 

It is flavourless so most cats tolerate this well.

 

Buprenorphine Subcutaneous


Subcutaneous buprenorphine has long been considered to be ineffective at standard (0.02mg/kg) doses. A review of the studies using buprenorphine in cats (2014) Steagall PVM, Monteiro-Steagall BP & Taylor PM Journal of Veterinary Internal Medicine 28 pp762-70 says "At clinical dosages, the SC route of administration does not appear to provide adequate antinociception and analgesia." 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "in cats, the subcutaneous (SC) route of opioid administration is not recommended."

 

Increasing the doses would not necessarily make buprenorphine work more effectively, because it is known for having a "ceiling effect." Mar Vista Vet explains "While buprenorphine is commonly dispensed for three times daily usage, how long a dose lasts actually depends on the size of the dose. This is possible because of buprenorphine's "ceiling effect" which means that once a maximum effect has been reached (i.e. all the receptors have been bound with drug), giving more buprenorphine does not create a greater effect. Instead, the higher the dose, the longer the effects last."

 

Recent research indicates that giving more concentrated doses subcutaneously may actually provide effective pain relief for longer periods without adverse effects. Pharmacokinetic and pharmacodynamic evaluation of high doses of buprenorphine delivered via high-concentration formulations in cats (2016) Taylor PM, Luangdilok CH & Sear JW Journal of Feline Medicine and Surgery 18(4) pp290-302 looked at the effectiveness of buprenorphine given subcutaneously to healthy cats. The study found that higher doses lasted for over 24 hours, sometimes close to 48 hours. The study concludes "0.12 and 0.24 mg/kg doses of aqueous buprenorphine given subcutaneously appear to provide at least 24 h antinociception with no side effects other than mydriasis [dilated pupils]".

 

Newer formulations have been released as follows:

 

Simbadol


Simbadol is a form of buprenorphine which is given by subcutaneous injection and which is said to last for 24 hours, so it only needs to be given once a day.

 

Pharmacokinetic and pharmacodynamic modelling after subcutaneous, intravenous and buccal administration of a high-concentration formulation of buprenorphine in conscious cats (2017) Doodnaught GM, Monteiro BP, Benito J, Edge D, Beaudry F, Pelligand L & Steagall P PLoS ONE 12(4) e0176443 looked at Simbadol and concluded "The SC administration of Simbadol was characterized by prolonged absorption half-life and sustained plasma concentrations yielding long-lasting antinociception (24 hours) when compared with the IV and OTM routes."

 

Buprenex SR


Buprenex SR is a sustained release form of buprenorphine which is given by subcutaneous injection and which is supposed to last for 72 hours.

 

Buprenorphine Dosage


The doses given below are commonly used in cats. However, A review of the studies using buprenorphine in cats (2014) Steagall PVM, Monteiro-Steagall BP & Taylor PM Journal of Veterinary Internal Medicine 28 pp762-70 says "Cats may have great individual variability with respect to the number, morphology, and distribution of opioid receptors relative to other species..., so buprenorphine may not provide sufficient analgesia in some cats, and it may be very effective in others. Analgesic protocols should be tailored to the individual patient."

 

Transmucosal


The usual dose is 0.01-0.03 mg/kg, which is given up to three times a day. Here is a table showing what this means for cats of different weights:

 
Cat Weight Dosage in mg
  0.01 mg/kg dose 0.02 mg/kg dose 0.03 mg/kg dose
5 lb   (2.27kg) 0.0227 0.454 0.068
8 lb   (3.64kg) 0.0364 0.728 0.109
10 lb   (4.5kg) 0.0450 0.090 0.135

Most injectable buprenorphine (which is what you will probably be using, but applying to the cheek) comes in a 3mg/ml strength. Since these are tricky amounts to calculate, many vets provide small syringes containing the correct dose and you just gently squeeze the contents into your cat's mouth towards the cheek.

 

Subcutaneous


The usual dosage of Simbadol ( 1.8 mg/mL) is 0.24 mg/kg (0.11 mg/lb) administered subcutaneously once daily, for up to 3 days.

 

Buprenorphine Sources


Buprenorphine is available in vials (not usually offered to clients in the USA) or small prefilled syringes, each containing about 1ml of buprenorphine. These contain injectable buprenorphine, but  it is safe to give this into the cheek (as long as it is not the sustained release version).

 

Since the introduction of sustained release buprenorphine, some vets are no longer supplying syringes to clients for home use (since buprenorphine is a controlled drug), and instead are only prepared to administer the subcutaneous sustained release injectable version in their office. This would require two trips to the vet each week, which is not ideal for most people or cats.

 

Some people prefer to obtain oral suspension buprenorphine instead.

 

USA


Diamondback Drugs

This compounding pharmacy is used by many members of Tanya's CKD Support Group for buprenorphine. It offers an oral suspension made from a powder mixed with preserved water which you can then apply to your cat's cheek inside the mouth.

 

The strength dispensed is typically 0.3mg/ml. It will dispense the product as directed by your vet, but the price is the same for any amount up to 30 mls, which is good for up to 180 days.

 

The price as at August 2017 was US$38 for a bottle up to 30 ml in size plus US$8 flat rate shipping.

 

You will also need syringes to draw up and give the medication.

 

Diamondback also compound an injectable form in an 0.6 mg/ml strength which comes in a 10 ml vial, but this is probably too high a strength for most cats, plus it contains a preservative which may sting.

 

UK


In the UK you will often be offered buprenorphine for home use in 5ml or 1ml vials. Although the 5ml and 10ml vials tend to be cheaper, it is better to buy the 1ml vials because there is a preservative added to the larger size vials which gives the medication an unpleasant taste.

 

Buprecare is one possible brand, which is available in a 0.3mg/ml strength. This product does not contain a preservative.

 

VioVet

Sells buprenorphine with a prescription for Ł16 for five 1mg vials of the 0.3mg/ml strength.

 

Buprenorphine Side Effects


The most common side effect is sedation. This may improve as the cat's body gets used to the medication.

 

You may see dilated pupils. Pharmacokinetic and pharmacodynamic evaluation of high doses of buprenorphine delivered via high-concentration formulations in cats (2016) Taylor PM, Luangdilok CH & Sear JW Journal of Feline Medicine and Surgery 18(4) pp290-302 says "there were no adverse effects other than mild mydriasis, which is usually seen in cats treated with buprenorphine at low doses anyway."

 

Buprenorphine makes some cats purr more and become very affectionate, whilst other cats become restless.

 

The main concern is respiratory depression, which may be seen as slowed breathing and/or shallower breathing. However, Plumb's Veterinary Drugs Handbook (7th Ed.) says this is rare, though it advises that buprenorphine "should be used cautiously in patients with compromised cardiopulmonary function."

 

Buprenorphine is cleared by the liver so it tends to be a good choice for CKD cats who need ongoing pain control. However, cats with CKD may eliminate it more slowly. Plumb's Veterinary Drugs Handbook says "All opiates should be used with caution in patients with... severe renal insufficiency... and in geriatric or severely debilitated patients." Discuss with your vet whether to lower the dose.

 

Virtually everybody I've heard from has found buprenorphine extremely effective with few side effects.

 

Buprenorphine Interactions


Be careful if you are using buprenorphine with cyproheptadine (an appetite stimulant) because using both together may result in an increased sedative effect.

 

Drugs mentions that the risk of respiratory depression is increased if buprenorphine is used concomitantly with gabapentin.

 


Fentanyl (Duragesic)


 

Fentanyl is a narcotic belonging to the same drug family (opioids) as buprenorphine and morphine. Therefore it is a very effective painkiller.

 

Mar Vista Vet has some information about Fentanyl.

Fentanyl Formulations


Fentanyl is usually given in the form of a patch (like a plaster) on the skin which slowly releases the medication for 4-5 days.

 

My Indie (non-CKD) had extensive dental extractions, and was given a fentanyl patch to help her oral pain. The patch was applied to a small area of shaved skin on one of her back legs, and lasted for several days. It worked very well for her, she was a little subdued but that was the only side effect (which might actually have been due to the after effects of the surgery). However, up to a third of cats absorb less of the medication than is needed for effective pain control, so be aware of the signs of pain in cats so you can ensure it is working properly for your cat.

 

Fentanyl Side Effects


Side effects are uncommon and usually minor e.g. allergy to the patch adhesive.

 

The most common serious side effect (although it is still relatively rare) is an adverse effect on breathing, which may manifest itself as lethargy. Fortunately removing the patch should quickly resolve any problems.

 

Care should be taken to ensure that the cat cannot remove the patch or lick it.

 

Fentanyl Interactions


Fentanyl should not be used in cats taking selegiline (Anipryl) for cognitive dysfunction.

 

Heat can increase the amount of fentanyl released, which could be very dangerous, so access to heat (e.g. heated cat beds) should be removed for any cat with a fentanyl patch.

 


Tramadol (Ultram)


 

Strictly speaking tramadol is not an opiate but it has some effect on opioid receptors, so I am including it in this category.

 

Mar Vista Vet has some information about Tramadol. It says "The beauty of tramadol as a pain reliever is that it is compatible with all the COX-inhibiting non-steroidal anti-inflammatory drugs, possibly even synergizing with them. The same is true with tramadol combined with gabapentin and amantidine. It is also compatible with joint pain nutriceuticals such as glucosamine, MSM, chondroitin sulfate etc."

 

Wedgewood Pharmacy gives an overview of Tramadol.

 

Pain medicine: Tramadol Moses L Angell Animal Medical Center explains that response to tramadol varies from patient to patient, and that it may be better to use it in conjunction with other pain control methods.

Tramadol Formulations


Tramadol is available in tablet and liquid form in a variety of sizes, but the 50mg tablets are often used in cats.

 

Tramadol is available as a generic which means it is inexpensive.

Unfortunately, tramadol tastes very bitter to cats, so it is wise to give it in a gelcap.

 

Tramadol Dosage


Tramadol is dosed at 1 to 2 mg/kg 2-3 times a day, so a 10 lb (4.5kg) cat would receive 4.5 - 9mg 2-3 times a day.

 

In practice many people simply start with a quarter of a 50mg tablet (12.5mg) twice a day, but of course be guided by your vet.

 

Tramadol is metabolised largely by the liver but around 30% is excreted by the kidneys so your vet may wish to reduce the dose for a CKD cat.

 

Mar Vista Vet mentions that if tramadol is used longer term, it should be tapered off rather than stopped suddenly.

 

Tramadol Side Effects


Tramadol is a safe treatment when used at appropriate dosage levels and side effects are rare, but include sedation, loss of appetite, vomiting and constipation. Dilated pupils may also be seen in cats.

 

Tramadol has been known to cause hallucinations and seizures in humans so should be used with caution in cats with a history of seizures.

 

Tramadol Interactions


Ondansetron inhibits the analgesic effects of tramadol: a possible 5-HT3 spinal receptor involvement in acute pain in humans (2002) Arcioni R, della Rocca M, Romano S, Romano R, Pietropaoli P & Gasparetto A Anesthesia and Analgesia 94(6) pp1553-7 reports that ondansetron (commonly used for nausea in CKD cats) may reduce the painkilling effects of tramadol by up to 50% in humans.

 

Be careful if you are using tramadol at the same time as cyproheptadine (an appetite stimulant) because using both together may reduce the effectiveness of the tramadol.

 

Mar Vista Vet mentions that using tramadol at the same time as another appetite stimulant called mirtazapine may increase the risk of serotonin syndrome.

 


Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)


 

Non-steroidal anti-inflammatory drugs help to reduce inflammation and may offer some degree of pain control. ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats (2010) Sparkes AH, Heiene R, Lascelles BDX, Malik R, Real Sampietro L, Robertson S, Scherk M & Taylor P Journal of Feline Medicine and Surgery 12 pp521-538 provide guidelines for their use. The guidelines are also available in French, German, Japanese and Spanish here.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Mechanism


NSAIDs work by blocking prostaglandin production. They do this by binding with enzymes called cyclo-oxygenase (COX).

 

There are two forms of COX:

  • COX-1 is protective, particularly in the kidneys and the digestive tract.

  • COX-2 produces pain and inflammation.

  • Therefore the goal is often to reduce levels of COX-2 while not affecting COX-1.

Reducing levels of COX-2 only does not entirely remove the risk of side effects. 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "Studies indicate that NSAiDs that spare cyclooxygenase (CoX)-1 produce a lower frequency of Gi lesions, although the more highly CoX-2selective inhibitors may actually produce more adverse events when underlying gastric damage is already present."

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Advantages


Most NSAIDs used in cats are relatively cheap and very effective. They are usually supplied in formulations that are easy to give too.

 

Because they are anti-inflammatory, NSAIDs can be very effective, especially for chronic conditions such as arthritis. 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "The majority of conditions that cause pain have an inflammatory component. Non-steroidal anti-inflammatory drugs (NSAiDs) are a mainstay for management of chronic pain as well as for perioperative use."

 

As regards safety, they also state "NSAiDs should be used for their central and peripheral effects in both dogs and cats after consideration of risk factors. There is no indication that any one of the veterinary-approved NSAiDs is associated with any greater or lesser incidence or prevalence of adverse events."

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Disadvantages


Unfortunately cats tend to metabolise NSAIDs poorly, so historically many vets have been reluctant to use these drugs in cats because of the risk of side effects. Pet Poison Helpline explains more about the risks of using NSAIDs and what warning signs to watch for.

 

2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 state "of the adverse events associated with NSAiDs, gastrointestinal (Gi) toxicity is the most common. In cats, inappetence appears to be the most common adverse event." It also says "Although the overall incidence and prevalence of NSAiD-related toxicity is unknown, it does appear to be very low relative to the number of doses administered."

 

Research indicates that NSAIDs are usually safe for short-term use in healthy cats when used appropriately. Effects of non-steroidal anti-inflammatory drugs (NSAIDs) on renal function (2007) Brown SA State of the Art in Renal Disease in Dogs and Cats Proceedings, Vetoquinol Academia reports (page 31) on the use of NSAIDs in CKD. Dr Brown states "It has long been known that NSAIDs have a good margin of renal safety for short- term use in healthy animals."

 

However, many cats require NSAIDs longer-term, e.g. to treat arthritis, and oral NSAIDS are approved for use longer-term in cats in some countries. However, caution is still advised for cats with certain problems such as CKD. 2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say "Be cautious or avoid NSAIDs in patients with the following existing/anticipated conditions:

– Low-flow states such as dehydration, hypovolemia, congestive heart failure and hypotension.

– Renal, cardiac or hepatic dysfunction."

See below for more information on the use of NSAIDs in cats with CKD.

 

NSAIDS should not be used at the same time as corticosteroids.

 

Close monitoring is required if NSAIDs are used in cats taking ACE inhibitors such as benazepril or diuretics because using these treatments together increases the risk of kidney problems.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used in Cats


The NSAIDs most commonly used in cats are:


Meloxicam (Metacam or Meloxidyl)


 

Meloxicam is a non-steroidal anti-inflammatory drug that may be used in cats for acute or chronic pain.

 

Meloxicam is a COX-2 preferential NSAID, i.e. it works effectively on COX-2 to reduce pain and inflammation, but it also reduces levels of COX-1 to some degree. See above for more about this.

 

Pet Place has some information about meloxicam.

 

Mar Vista Vet also has some information about meloxicam.

Meloxicam Formulations and Usage


Meloxicam is available in both injectable and oral (liquid) form, as follows:

 

USA


  • Only approved (under the trade name of Metacam) for use in cats in the injectable form.

  • Intended to be a one-off treatment as a painkilling injection following surgery.

  • A canine oral version is available which is sometimes used off-label in cats.

Europe


  • The injectable form is approved for one-off use in cats following surgery, the same as in the USA.

  • An oral form was licensed in 2007 for use in cats for longer term pain management e.g. in cats with arthritis, under the trade name of Metacam.

  • Another oral form was licensed in 2011 for use in cats for longer term pain management e.g. in cats with arthritis, under the trade name of Meloxidyl.

Meloxicam Risks and Benefits


Many people are frightened to use meloxicam in their cats, particularly in cats with CKD. This is largely because a Freedom of Information Summary (2004) US Food and Drug Administration stated (page 23) that, following the use of Metacam for post-operative pain, 8.3% of the cats in the study had elevated BUN levels, and 12.5% had anaemia (anaemia is common in cases of inflammation, which may partly explain this finding, since meloxicam is an anti-inflammatory medication). The paper concludes: "Meloxicam, when initially dosed as a subcutaneous injection followed by oral dosing for nine days at > 0.3 mg/kg was associated with severe adverse effects, including death."

 

This was followed in October 2010 by the Food and Drug Administration announcing that a "black box warning" would be added to meloxicam. The black box warning states: "Warning. Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See contraindications, warnings and precautions for detailed information."

 

Other countries take a different view of meloxicam, as shown by their approval of oral versions of meloxicam for longer term use in cats. In fact, research since the black box warning was issued in 2010 indicates that meloxicam can be safe for healthy cats, and even for CKD cats as long as safety guidelines are followed.

 

Effects of meloxicam on plasma iohexol clearance as a marker of glomerular filtration rate in conscious healthy cats (2009) Goodman LA, Brown SA, Torres BT, Reynolds LR & Budsberg SC American Journal of Veterinary Research 70(7) pp826-30 checked the glomerular filtration rate (a measure of kidney function) in six healthy cats before and after short-term administration of meloxicam and did not find any deterioration.

 

Subsequent studies looked at the longer term use of meloxicam. Long-term safety, efficacy and palatability of oral meloxicam at 0.01-0.03mg/kg for treatment of osteoarthritic pain in cats (2008) Gunew MN, Menrath VH, Marshall RD Journal of Feline Medicine & Surgery 10(3) pp235-41 monitored forty cats who were given meloxicam for arthritis for almost six months, three of whom had pre-existing renal disease. The study found that "no deleterious effect on renal function was detected in cats studied."

 

Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease (2011) Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA, Malik R Journal of Feline Medicine & Surgery 13(10) pp752-761 retrospectively examined the records of a veterinary practice over a five year period and concluded that "long-term therapy with meloxicam at a median dose of 0.02 mg/kg/day can be administered safely to aged cats with CKD, provided they are clinically stable. The results further suggest that meloxicam may actually slow the progression of renal disease in cats with both DJD and CKD by direct or indirect mechanisms." The study goes on to speculate that meloxicam might slow the progression of CKD by reducing proteinuria (studies indicate that medications in the same family as meloxicam can reduce proteinuria in humans and rats).

 

A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease (2012) Gowan RA, Baral RM, Lingard AE, Catt MJ, Stansen W, Johnston L & Malik R Journal of Feline Medicine and Surgery 14(12) pp876-81 looked into the use of meloxicam in cats with CKD. This study examined the records of 82 cats over the age of seven who had been given meloxicam for six months or longer. 47 of the cats were known to have CKD, the other 35 showed no obvious signs of CKD. The most common cause of death in both groups was cancer, not CKD. The study concluded "the survival data presented here confirm that many cats with carefully managed CKD can survive for a substantial period with standard medical therapy. In addition, long-term treatment with oral meloxicam did not appear to reduce the lifespan of cats with pre-existent stable CKD, even for cats in IRIS stages II and III."

 

Meloxicam can be very helpful for cats with arthritis. There is more information about using it in cats with arthritis here.

 

Meloxicam Dosing


The dosage used appears to be critical when it comes to benefiting from meloxicam whilst reducing the risk of any problems.

 

It is also important not to use oral meloxicam after injectable meloxicam. I know many vets do offer oral meloxicam following the use of injectable meloxicam during surgery such as spaying, but it should be noted that the manufacturer says "Metacam 0.5 mg/mL Oral Suspension for Cats should not be used following parenteral injection of meloxicam or any other NSAID as appropriate dosage regimens for such follow-up treatments have not been established."

 

Meloxicam Dosing: Healthy Cats


For healthy cats, the dose of the oral medication recommended by one manufacturer for the treatment of chronic pain in cats is:

  1. a single oral dose of 0.1 mg meloxicam/kg body weight on the first day.

  2. a maintenance dose of 0.05 mg meloxicam/kg body weight once daily thereafter at 24 hour intervals.

  3. "For longer term treatment, once clinical response has been observed (within 7 days), the dose of Metacam can be adjusted to the lowest effective individual dose reflecting that the degree of pain and inflammation associated with chronic musculoskeletal disorders may vary over time."

Adverse reactions to meloxicam have been reported much more frequently in the USA than in countries where oral meloxicam is approved for longer term use in cats. This may be because those countries provide vets with guidelines on suitable doses for cats, which is not the case in the USA.

 

The fact that the USA has not approved a feline formulation may actually be contributing to the problem, because vets in the USA who wish to prescribe meloxicam off-label for a feline patient have to prescribe the canine version, which is three times as strong as the feline version available in other countries. Vets should of course be reducing the dose for their feline patients, but since meloxicam is often dosed in drops rather than precise measurements, it may be that they are instructing their clients to give it in drops (Metacam comes with a dropper dispenser) directly into the cat's mouth rather than measuring it out in mg first, and thus not adjusting the dose appropriately and safely for cats.

 

If your cat develops kidney problems following the use of meloxicam, please see below for information on how best to treat it, and how to report it to the authorities.

 

Meloxicam Dosing: CKD Cats


If you wish to use meloxicam in a CKD cat, one option is to give half of the dose that you would give to a healthy cat of the same weight and see if it helps your cat. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease (2011) Gowan RA, Lingard AE, Johnston L,  Stansen W, Brown SA, Malik R Journal of Feline Medicine & Surgery 13(10) pp752-761 retrospectively examined the records of a veterinary practice over a five year period and concluded that "long-term therapy with meloxicam at a median dose of 0.02 mg/kg/day can be administered safely to aged cats with CKD, provided they are clinically stable."

 

Please note the study refers to cats with stable CKD. If your cat has recently crashed, or is dehydrated or is not eating, meloxicam is unlikely to be suitable. The study also says "Adverse effects on the kidney occur when NSAIDs are used in cats that are dehydrated, hypovolaemic or hypotensive, but meloxicam is not of itself nephrotoxic, and there is evidence that for cats with stable CKD and chronic pain, use of low dose meloxicam can achieve improved survival and maintenance of bodyweight with no acceleration of renal deterioration."

 

ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats (2010) Sparkes AH, Heiene R, Lascelles BDX, Malik R, Real Sampietro L, Robertson S, Scherk M & Taylor P Journal of Feline Medicine and Surgery 12 pp521-538 has a box on page 530 which explains the precautions that should be taken when using NSAIDs in cats with renal disease.

 

Meloxicam: Whether To Use


Some people refuse to use meloxicam for any of their cats, healthy or otherwise, preferring to rely on other medications, usually painkillers.

 

I do not personally view meloxicam as a last resort treatment. Yes, there are other treatments available for pain control in cats, but meloxicam is anti-inflammatory, whereas most of the alternatives are simply painkillers. Meloxicam is also usually easy to give, very effective and reasonably priced.

 

I would definitely consider using meloxicam for a cat whose kidneys appeared fine in tests and who would benefit from it, such as my arthritic Karma. In fact, I wish I had started Karma on it far sooner than I did. Buying into the fear of using NSAIDs in cats, I did not start giving Karma meloxicam until she was already sixteen years old and had had arthritis for some years. I am still kicking myself for not giving it to her sooner, because the difference was like night and day: she was just so much happier and more active once her pain was under control.

 

We also used meloxicam for Harpsie when his arthritis flared up acutely following a fall off a sofa while we were out and he was in dreadful pain which other medications did not seem to help (he was literally screaming). It worked very well and caused no long term problems for him, but since Harpsie had PKD, we only used it at a very low dose, and much less frequently than normally recommended, and it still controlled the pain effectively. We checked his kidney values a month later (they were fine).

 

If either of them had had CKD, I would still have considered using it (at very carefully dosed levels with regular monitoring), bearing in mind that controlling pain is more important for quality of life than anything else. It may be better for me to keep my cats around for as long as possible, but I am not convinced that it is better for my cats to live a longer but pain-filled life.

 

Meloxicam Interactions


Close monitoring is required if NSAIDs are used in cats taking ACE inhibitors (such as benazepril or enalapril) or diuretics because using these treatments together increases the risk of kidney problems.

 

Do not use meloxicam at the same time as corticosteroids.

 

Development of an injection site sarcoma shortly after meloxicam in an unvaccinated cat (2011) Munday JS, Banyay K, Aberdein D, French AF Journal of Feline Medicine & Surgery 13(12) pp988-91 reports on a cat who developed sarcoma (a form of cancer) where meloxicam was injected. This is extremely rare.

 

Meloxicam: Dealing with Adverse Reactions


Most cats who develop kidney problems after using meloxicam are suffering from acute kidney injury (AKI). Therefore their kidney values in blood tests may be extremely high, with creatinine often in the high teens.

 

A treatment programme which includes 4-5 days of IV fluid therapy (hospitalisation), followed by 4-6 weeks of sub-Q fluids at home, is often recommended by the manufacturers, but talk to them (see below) and see what they suggest for your cat.

 

I would also suggest that you ask the manufacturers to pay your veterinary costs - I know they have done this for some people, although they have not necessarily paid the full costs. It would appear that they may pay more if your vet calls.

 

Do not give up hope! Acute kidney injury is difficult to treat, but not impossible: an aggressive treatment plan should see those numbers dramatically reduce in most cases, and in some cases a complete recovery from a case of acute kidney injury is possible. In fact, one person was told by the manufacturer of Metacam that 77% of cats affected by meloxicam make a full recovery with prompt and proper treatment, so don't opt for euthanasia immediately.

 

However, I understand that the manufacturer considers a creatinine in the 3 mg/dl range to indicate that the cat is stabilised, and whilst this is certainly not a critical level nor grounds for euthanasia, it does indicate some residual kidney damage. 

 

Meloxicam: Reporting Adverse Reactions


If you believe your cat has developed kidney disease as a result of using meloxicam, you should report this as follows:

 

USA


If you have used Metacam, contact the manufacturer on 1-866-METACAM (638-2226). You  may find yourself speaking to a Dr Carey or a Dr Grubb, but whoever you talk to should be able to work with your vet to devise a treatment plan.

 

You should also make a report to the Food & Drug Administration. Apparently the manufacturers are not obliged to report any cases of kidney problems to the FDA because renal failure is already listed in the package insert as a possible side effect, but I believe it is very important for the FDA to be fully aware of the scale of the problem. FDA Consumer Complaints Co-ordinator has details of the relevant contacts for each state.

 

Canada


The manufacturer's contact number is 1-800-325-9167, though they will only speak to vets.

 

You should also report it to the Veterinary Drugs Directorate.

 

UK


You should report it to the Veterinary Medicines Directorate.

 

Meloxicam Research


There is interest in using meloxicam for reasons other than pain control, as follows:

 

Slowing the Progression of CKD


In light of the studies mentioned above, which seemed to indicate that meloxicam might slow the progression of CKD in cats, a study has recently closed at the University of Kansas Veterinary Health Center. You can read more about it here.

 

Cancer, Particularly Squamous Cell Carcinoma (SCC)


There is some evidence that meloxicam may help cats with certain cancers, including oral squamous cell carcinoma, a cancer that can be very difficult to treat. A review of feline oral squamous cell carcinoma (2016) Pellin M & Turek M Today's Veterinary Practice Nov/Dec 2016 pp24-33 says "use of COX-inhibiting anti-inflammatory medications may have several beneficial effects in cats with SCC, including:

  • Pain relief
  • Reduction of neoplasia-associated inflammation and edema
  • Potentially, anticancer effects, such as disease response or stabilization."

Robenacoxib (Onsior)


 

Robenacoxib is a non-steroidal anti-inflammatory drug (NSAID). It is somewhat different to meloxicam in that it is a COX-2 selective NSAID, i.e. it works effectively on COX-2 to reduce pain and inflammation but does not affect levels of COX-1. See above for more about this.

 

Mar Vista Vet has some information about robenacoxib.

 

Robenacoxib Formulations and Usage


Robenacoxib is only approved for short-term use in cats. You may be offered it if your cat undergoes surgery or has a serious arthritis flare up.

 

There is more information about using robenacoxib in cats with arthritis here.

 

USA


  • Approved since 2011 for use in cats to control post-operative pain and inflammation.

  • Can be used once daily for up to three days.

Onsior is the manufacturer's US website.

 

UK


  • Approved since 2009 for use in cats for the treatment of acute pain and inflammation associated with musculoskeletal disorders (e.g. arthritis).

  • Can be used for up to six days.

The National Office of Animal Health in the UK has some information about Onsior.

 

Robenacoxib Dosage


Doses should be administered approximately 30 minutes before surgery.

 

Robenacoxib should not be used in cats weighing less than 2.5kg (5.5lbs).

 

USA


Tablets

  • 1 mg/kg (0.45 mg/lb) orally once daily for up to maximum of 3 days. Use the lowest effective dose for the shortest time necessary to obtain the necessary effect for the individual.

Injection

  • 2 mg/kg (0.91 mg/lb) subcutaneously once daily for up to a maximum of 3 days. Subsequent doses can be given via subcutaneous injection or interchanged with oral tablets.

UK


Tablets

  • 1 mg/kg (0.45 mg/lb) (but with a range of 1-2.4mg/kg) orally once every 24 hours for up to a maximum of 6 days for musculoskeletal disorders.

  • A single oral treatment may also be given prior to orthopaedic surgery, and once daily treatment may be continued for two further days

Injection

  • 2 mg/kg (0.91 mg/lb) subcutaneously given 30 minutes before surgery. After this, once daily treatment may be continued at the same time every day for up to two days

Robenacoxib Side Effects


According to the manufacturer, a number of studies were conducted on robenacoxib in cats, including a 21-day, 42-day and six-month study at up to 10 times the daily dose approved for use. Side effects seen in some cats included mild, temporary diarrhoea and vomiting. Vomiting, neurological signs, intestinal ulceration, increased liver enzymes and kidney damage were seen at higher doses.

 

Since robenacoxib is 30% excreted by the kidneys, it should be used with caution in cats with CKD, who should be monitored closely. Clinical safety of robenacoxib in feline osteoarthritis: results of a randomized, blinded, placebo-controlled clinical trial (2015) King, JN, King S, Budsberg SC, Lascelles BD, Bienhoff SE, Roycroft LM & Roberts ES Journal of Feline Medicine and Surgery 9 pp1-11 looked at the safety of using robenacoxib longer term in 194 cats with arthritis, including some cats (40) with both arthritis and CKD. The cats who did not receive the placebo were given 1.0-2.4 mg/kg  of robenacoxib orally daily for 28 days. The study concludes "Robenacoxib was well tolerated when administered daily for 1 month in cats with osteoarthritis, including cats with evidence of concurrent CKD. There was no clinical indication of damage to the gastrointestinal tract, kidney or liver."

 

Robenacoxib Interactions


Do not use robenacoxib at the same time as corticosteroids.

 

Close monitoring is required if it is used in cats taking ACE inhibitors such as benazepril or diuretics because using these treatments together increases the risk of kidney problems.

 


Other Painkillers



Gabapentin


Gabapentin is an anti-convulsant, i.e. a medication which is used to prevent seizures. Although nobody actually knows why, it has also been found to help with pain, particularly neuropathic (nerve-related) pain or arthritic pain.

 

Long-term use of gabapentin for musculoskeletal disease and trauma in three cats (2013) Lorenz ND, Comerford EJ & Iff I Journal of Feline Medicine and Surgery 15(6) pp507-12 looked at the use of gabapentin for arthritic pain in cats. Results "indicated that satisfactory pain management was achieved, administration was easy and no obvious side effects during the period of administration occurred."

 

Wedgewood Pharmacy for Veterinary Practices says "It appears to be most effective when combined with other types of analgesic agents, for example NSAIDs, permitting the use of lower doses."

 

Mar Vista Vet has an overview of gabapentin.

 

Pet Place discusses gabapentin.

 

Gabapentin Formulations


The smallest size of tablet available is 100mg tablets.

 

There is a liquid formulation available, but this contains xylitol, which is toxic to dogs. There is currently no evidence that it is toxic to cats, and Plumb's Veterinary Drug Handbook says "In cats, at the dosages used presently, xylitol toxicity does not appear to be a problem with gabapentin oral solution, but use with caution." Still, some people prefer to avoid products containing it.

 

Therefore many people have gabapentin compounded for their cats. However, people giving a higher dose (see dosing below) can usually cut the 100mg tablets to an appropriate size.

 

Gabapentin Dosage


Pet Place says "For pain control in cats, doses range from 1.5 to 5 mg per pound (1.25 to 2.5 mg/kg) every 12 hours. Higher doses (up to 50 mg per cat 1 to 3 times daily) are recommended by some vets."

 

Long-term use of gabapentin for musculoskeletal disease and trauma in three cats (2013) Lorenz ND, Comerford EJ & Iff I Journal of Feline Medicine and Surgery 15(6) pp507-12 states that "All cats received gabapentin for several months at an average dose of 6.5 mg/kg q12h."

 

Gabapentin does not have long lasting effects (it reaches peak levels in the blood in cats about 1.5 hours after dosing, and falls thereafter), so many people find they do need to give it three times a day, which can be tricky if you have to go out to work.

 

Gabapentin is excreted via the kidneys so some vets reduce the dose for CKD patients, who need close monitoring while on the drug. Plumb's Veterinary Drug Handbook (7th Ed.) mentions with regard to side effects, "Starting the dose at the lower end of the range and increasing with time may alleviate these effects."

 

Gabapentin should not be stopped suddenly but gradually tapered down.

 

Gabapentin Side Effects


Some people believe it may be risky to give anti-seizure medication to a cat who has never had a seizure, though the doses given for pain relief are lower than those given when it is used as a seizure medication. Gabapentin does appear to be safe for cats, with very few side effects.

 

The primary side effect is sedation. Ataxia (stumbling, wobbliness) may also be seen. Plumb's Veterinary Drug Handbook (7th Ed.) says "Sedation and ataxia are probably the most likely adverse effects seen in small animals. Starting the dose at the lower end of the range and increasing with time may alleviate these effects. In humans, the most common adverse effects associated with gabapentin therapy are dizziness, somnolence, and peripheral edema."

 

Because of its sedative effects, there is actually research into the use of gabapentin as a mild sedative for cats in certain situations. Effects of a single preappointment dose of gabapentin on signs of stress in cats during transportation and veterinary examination  (2017) van Haaften KA, Forsythe LRE, Stelow EA & Bain MJ Journal of the American Veterinary Medical Association 251(10) pp1175-1181 looked at its effectiveness for vet visits. The study states "Sedation was a common effect of gabapentin administration, and ataxia, hypersalivation, and vomiting were also reported. All effects resolved within 8 hours after gabapentin administration."

 

Investigating appropriate dosing for gabapentin sedation in cats with and without chronic kidney disease is a study looking into the safe use of gabapentin in this way for CKD cats.

 

Plumb's Veterinary Drug Handbook (7th Ed.) says "Because gabapentin is eliminated via renal routes (practically 100% in humans), it should be used with caution in patients with renal insufficiency."

 

Gabapentin Interactions


Mar Vista Vet mentions that oral antacids such as famotidine (Pepcid), ranitidine (Zantac) or cimetidine (Tagamet) will reduce the absorption of gabapentin by up to 20%. Therefore you should give these medications at least two hours apart.

 


Painkillers Research


 

Frunevetmab (Anti-Nerve Growth Factor Antibody)


Nerve growth factor (NGF) is present in the body where there is inflammation or injury, and contributes to pain from such conditions. Previous research has shown that neutralising antibodies against nerve growth factor are effective painkillers for rodents, chronic pain in humans and arthritis in dogs.

 

A feline-specific anti-nerve growth factor antibody improves mobility in cats with degenerative joint disease-associated pain: A pilot proof of concept study (2016) Gruen ME, Thomson AE, Griffith EH, Paradise H, Gearing DP & Lascelles BD Journal of Veterinary Internal Medicine 30(4) pp1138-1148 examined the efficacy of an anti-NGF antibody called NV-02 (frunevetmab) for arthritic pain and mobility problems in cats. The study concluded "These pilot data demonstrate a 6-week duration positive analgesic effect of this fully felinized anti-NGF antibody in cats suffering from DJD-associated pain." The treatment appeared to have no side effects, with no apparent effect on kidney function.

 

In vitro and in vivo characterization of a fully felinized therapeutic anti-nerve growth factor monoclonal antibody for the treatment of pain in cats (2016) Gearing DP, Huebner M, Virtue ER, Knight K, Hansen P, Lascelles BDX, Gearing RP & Drew AC Journal of Veterinary Internal Medicine 30(4) pp1129-1137 induced temporary lameness in cats. It found that "Mean lameness scores on all days evaluated following initiation of treatment were significantly lower in the treatment group than in the control group."

 


Painkillers: Not Recommended


 

The following painkillers are not recommended for cats.


Aspirin


 

Aspirin is a non-steroidal anti-inflammatory drug. Aspirin can be toxic to cats, who can only metabolise it very slowly, so it is not usually used as a painkiller in cats.

 

Nevertheless, it is occasionally used to treat heart problems when the benefits outweigh the risks. In such cases it is usually only given in very low doses once every three days.

 

Aspirin may cause metabolic acidosis.

 

Mar Vista Vet has information on aspirin.

 


Carprofen (Rimadyl)


 

Carprofen is a non-steroidal anti-inflammatory drug used to treat arthritis in dogs. The manufacturer advises against using it in cats, so I would not use it.

 

Managing acute carprofen toxicosis in dogs and cats (2009) Volmer PA & Mensching D Veterinary Medicine reports on the risks of using carprofen and possible signs of toxicity.

 


Paracetamol/Acetaminophen


 

Paracetamol (UK) or acetaminophen or Tylenol (USA) is toxic to cats, with a very narrow safety margin, so even a tiny dose can be extremely dangerous.

 

Please never give your cat paracetamol/acetaminophen.

 

Tylenol (acetaminophen) toxicosis in cats (1998) Mladenovic D Indiana Animal Disease Diagnostic Laboratory at Purdue University explains more about this problem.

 

The 10 most common toxicoses in cats (2006) Dunayer EK & Merola V Veterinary Medicine June 2006 pp339-342 lists acetaminophen at number 8.

 

 

 

 

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This page last updated: 16 February 2018

 

Links on this page last checked: 16 February 2018

 

   

 

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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